口蓋裂患者の言語機能の評価と治療 [in Japanese] Evaluation and Treatment of Speech Function of Patients with Cleft Palate [in Japanese]
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Speech impairment is a serious problem faced by cleft palate patients in their early lives. Despite recent developments in surgical techniques, postoperative speech problems, including hypernasality and articulation disorders, are still reported. To improve speech quality in cleft patients, establishment of diagnostic and treatment guidelines based on an understanding of the pathology of cleft palate speech is necessary. In this article, our previous works on the establishment of the objective criteria for diagnosis of postoperative velopharyngeal incompetence (VPI) in cleft palate, the establishment of a new guideline for speech therapy of the postoperative VPI, craniopharyngeal characterization of the morphology of patients with persistent VPI, and three-dimensional analyses of palatal deformity as a possible cause of articulation disorders, are introduced. To establish objective criteria for diagnosis of velopharyngeal closure function (VPF), nasalance scores in cleft palate patients were calculated using Nasometer test. In the test, good VPF was diagnosed when the score averaged less than 20%, and poor VPF was suggested when the score averaged more than 40% and exceeded 80% on phonating the high-pressured sentence. Although an improvement in the acquired ratio of postoperative VPF from 60% to 90% has been recognized in the recent year, persistent VPI remains in approximately 10% in patients with cleft palate. The craniopharyngeal morphology of patients with persistent VPI was characterized by a short palate, a widebased counterclockwise rotation of the pharyngeal triangle. These items might be contributory factors for the prediction of VPF before surgical treatment of cleft palate. Further investigations are necessary to further improve understanding of the mechanisms involved in the occurrence of VPI and articulation disorders. This may lead to a more biological approach to the treatment of cleft palate speech.
- Annals of Kagoshima University Dental School
Annals of Kagoshima University Dental School (26), 9-19, 2006